Provider Update: October 7, 2019
To: ADvantage Case Management, Home Care, Adult Day Health, and Assisted
Subject:4% Rate Increases Approval
Due to numerous questions related to authorizations not yet appearing in Authenticare and OHCA, we are resending this bulletin with updated information.
The Medicaid Services Unit (MSU) was informed today of the approval of the 4% rate increases by the Centers for Medicare and Medicaid Services (CMS). The new rates will be effective on 10/1/2019.
The MSU worked with the Harmony vendor to perform a rate conversion to deploy the new rates, which will occur over this weekend. This rate conversion has been thoughtfully planned so as to cause as little disruption to service providers as possible.
- By the end of the day on 9/28/2019:
- Harmony will show all Planned Services and associated authorizations ending on 9/30/2019 at the old rate.
- New lines will be added at the new rate with a begin date of 10/1/2019.
- By 8:00 AM on Tuesday, 10/1/2019:
- The Oklahoma Health Care Authority (OHCA) system will be showing all lines as ending on 9/30/2019.
- By the end of the day on 10/1/2019:
- All lines with a 10/1/2019 start date will begin transmitting to OHCA.
- As OHCA can only consume 5000 new authorizations per day, it will likely take until the week ending 10/18/2019 for all lines to transmit to both OHCA and Authenticare.
NOTE:If you don't see a new line, please be patient; it should appear as the files are processed through all systems.
Data Conversion Process for State Plan Personal Care
- By 8:00 AM on Monday, 9/30/2019:
- Authenticare will show all ending 9/30/2019 lines and all beginning 10/1/2019 lines.
New Rates – ADvantage and State Plan Personal Care
|State Plan Service||Service Code||Unit Type||New Rate|
|Personal Care Assistant||T1019||¼ hour||$4.21|
|State Plan Skilled Nursing Assessment||T1001||Visit||62.40|
|ADvantage Waiver Services||Service Code||Unit Type||New Rate|
|Personal Care Assistant||T1019||¼ hour||4.21|
|Advanced Supportive/Restorative||T1019-TF||¼ hour||4.52|
|Respite - In Home||T1005||¼ hour||4.21|
|Respite - In Home Extended||S9125||Daily||175.55|
|CM Standard||T1016||¼ hour||15.29|
|Transitional CM Standard||T1016-U3||¼ hour||15.29|
|CM Very Rural||T1016-TN||¼ hour||21.89|
|Transitional CM Very Rural||T1016-TN-U3||¼ hour||21.89|
|Adult Day Health||S5100-U1||¼ hour||2.08|
|Adult Day Health - Therapies||S5105-TG||Episode||11.70|
|Adult Day Health - Personal Care||S5105||Episode||8.27|
|Adult Day Health – Laundry||S5105-U1||Episode||7.80|
|Assisted Living - Standard||T2031||Daily||48.99|
|Assisted Living - Intermediate||T2031-TF||Daily||66.11|
|Assisted Living - High||T2031-TG||Daily||92.47|
|Self-Directed – Personal Services Assistant||S5125||¼ hour||3.56|
|Self-Directed – Advanced Personal Services Assistant||S5125-TF||¼ hour||4.27|
|Physical Therapy||G0151||¼ hour||20.80|
|Occupational Therapy||G0152||¼ hour||20.80|
|Skilled Nursing Home Health Setting RN||G0299||¼ hour||15.60|
|Skilled Nursing Home Health Setting LPN||G0300||¼ hour||14.56|
|Extended State Plan Skilled Nursing RN||G0299-TF||¼ hour||15.60|
|Extended State Plan Skilled Nursing RN||G0300-TF||¼ hour||14.56|
|RN Assessment Evaluation||T1002||¼ hour||15.60|